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Member Outreach

Health insurance plans — both public and private — are rapidly expanding upon implementation of the Affordable Care Act. Plans are enrolling large volumes of new members, including new Medicaid recipients, individuals who were previously uninsured, and people with complex health care needs. Additionally, federal oversight for Medicaid and Medicare plans has made the member experience increasingly important, as plans are rated based on satisfaction, enrollment, and health care outcomes.

We have prioritized the member experience across all levels of services we provide for health plans. Our member outreach offerings include the following:

Welcome calls to engage members upon enrollment

Health risk assessments

Medication adherence outreach calls

Targeted Adherence Counseling

Comprehensive and targeted medication reviews

High-risk medication interventions

Member satisfaction surveys

Appointment scheduling and reminders

Referral follow-ups

Benefit coordination

Whether your organization is looking to simply engage and assist members, or develop targeted solutions to improve health outcomes, we can provide a solution to meet your needs. Our resources include the following:

A customer service contact center operated by our business affiliate, UHealthSolutions

The National Association of States United for Aging and Disabilities (NASUAD) has identified the MassOptions free online and helpline service as a “promising practice” in a set of Technology in Practice profiles. MassOptions was launched in 2015 by UMass Medical School, UHealthSolutions and the Massachusetts Executive Office of Elder Affairs.

Health plans can no longer ignore what happens after their members walk out of the doctor’s office. Too often members fail to follow through on the advice given by their primary physicians, leaving prescriptions unfilled or putting off badly needed diet and lifestyle changes. This can lead to costlier health problems and medical procedures down the line.

An overview of Medication Therapy Management (MTM) and the Star Rating measure. Learn the best practices for a successful MTM program, including the link to Comprehensive Medication Review quality and care management team integration.

On July 19-20, 2016, Mark Tesell of Clinical Pharmacy Services participated in the Academy of Managed Care Pharmacy (AMCP) Partnership Forum, Navigating Innovations in Diabetes Care, in Arlington, VA. This invite-only event brought together AMCP members, industry experts, and other key healthcare stakeholders together to discuss the impact of advances in diabetes treatments related to a range of new drugs, technology solutions and care management models. Recommendations were also made to optimize care and to manage increasing cost across pharmacy and medical benefits.

Situation

MTM has been practiced since the 1990's and was legislatively recognized with the Medicare Modernization Act of 2003, which required that Medicare Part D insurers provide MTM services to selected members. MTM was incorporated by the Centers for Medicare & Medicaid Services as a measure for Medicare Star Ratings in 2016.

Commonwealth Medicine and our business affiliate, UHealthSolutions, operate large, full-service, and clinically based call centers — ensuring that our clients are afforded all of the services they need to care for their consumers and improve health outcomes.

Our team provides a range of clinically-focused solutions to health and human services agencies and organizations, helping them reach their program goals of providing the appropriate care for the populations they serve.

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